Alcohol Use Disorder

The short version

●Alcohol use disorder (AUD) is a medical condition defined by impaired control over drinking, continued use despite harm, and often tolerance and withdrawal.
●It is common, serious, and very treatable — yet most people never receive evidence-based care.
●First-line treatment combines behavioral therapy with FDA-approved medications: naltrexone, acamprosate, and disulfiram.
●Alcohol withdrawal can be medically dangerous; heavy daily drinkers should not stop abruptly without medical guidance.
●Ketamine for AUD is investigational but promising: randomized trials suggest a ketamine infusion plus psychological therapy can increase abstinence.¹ ²
●This is an emerging research area, not standard care — AUD treatment belongs with addiction-trained clinicians, and any ketamine use would be within that specialist, research-informed context.

Clinical definition

AUD is a chronic, relapsing condition defined in DSM-5 by two or more of eleven criteria over a year — including drinking more or longer than intended, unsuccessful efforts to cut down, craving, failure to fulfill obligations, tolerance, and withdrawal — graded mild to severe by criterion count. It commonly co-occurs with depression and anxiety, each worsening the other. A central safety point is that physiological dependence makes abrupt cessation potentially dangerous (seizures, delirium tremens), so medically supervised withdrawal may be needed before any other treatment.

How it differs from related conditions

vs. Alcohol & substance use disorder

AUD is the alcohol-specific disorder within the broader substance-use category; principles overlap, but AUD has its own approved medications.

vs. Major depressive disorder

Depression and AUD frequently co-occur and amplify each other; treating one without the other limits recovery.

vs. Generalized anxiety disorder

People often drink to manage anxiety, which can entrench AUD; integrated treatment works better.

First-line treatments

Naltrexone / acamprosate

First-line FDA-approved medications that reduce craving and support abstinence; disulfiram for selected, motivated patients.

Behavioral therapy

CBT, motivational enhancement, and mutual-help approaches (SMART Recovery, AA) have strong evidence.

Medically supervised withdrawal when needed

For dependent drinkers, safe detox precedes other treatment because withdrawal can be dangerous.

Treating co-occurring depression/anxiety

Integrated care for common comorbidities improves outcomes.

When standard treatments fail

When standard treatment is not enough, options include switching or combining medications, higher levels of care (intensive outpatient, residential), and addressing co-occurring psychiatric conditions. Investigational approaches — including ketamine-assisted treatment — are being studied within addiction-specialist and research settings, not as routine care.

Where ketamine fits

AUD is an active and promising ketamine research area, but it remains investigational. Randomized trials have tested a ketamine infusion combined with psychological therapy: one found adjunctive ketamine with relapse-prevention therapy increased days of abstinence,¹ another paired a single infusion with motivational enhancement therapy,² and experimental work suggests ketamine may help "rewrite" maladaptive reward memories that drive drinking.³ These are encouraging early signals — not established treatment. Ketamine for AUD should be pursued, if at all, within an addiction-specialist or research context that pairs it with structured psychological therapy. Where AUD co-occurs with depression, the depression may be treatable on its own terms, with the drinking addressed in addiction care.

Where this fits with Tovani

Tovani treats depression and anxiety, which very commonly co-occur with alcohol use — but AUD itself is best managed by addiction-trained clinicians with the approved medications and behavioral therapies, and with attention to the real dangers of alcohol withdrawal. The ketamine-for-AUD evidence is investigational and delivered with structured therapy in research settings. If alcohol is part of your picture, we would focus on any treatable co-occurring depression while pointing you to proper addiction care. If you drink heavily and daily, do not stop suddenly without medical guidance.

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Frequently asked

Can ketamine help me stop drinking?

It is investigational, not standard care. Randomized trials pairing a ketamine infusion with psychological therapy have shown promising increases in abstinence, and experimental work suggests it may weaken reward memories that drive drinking. But it is early evidence, delivered with structured therapy in research settings — not a routine treatment.

What actually treats alcohol use disorder?

A combination of behavioral therapy (CBT, motivational enhancement, mutual-help groups) and FDA-approved medications — naltrexone, acamprosate, or disulfiram. Most people never get this evidence-based care, even though it works.

Is it dangerous to quit drinking suddenly?

It can be. If you drink heavily every day, abrupt cessation can cause dangerous withdrawal (seizures, delirium tremens). Talk to a clinician about medically supervised withdrawal rather than stopping cold turkey on your own.

I drink and I'm depressed — can Tovani help?

We can treat a co-occurring depression, which often improves recovery — but the alcohol use disorder itself belongs with addiction-trained care and the approved medications. The two are best treated together, by the right clinicians for each.

References

Grabski M et al. 2022, American Journal of Psychiatry — Adjunctive ketamine with relapse-prevention psychological therapy increased abstinence in alcohol use disorder (KARE trial). (PMID 35012326)
Dakwar E et al. 2020, American Journal of Psychiatry — A single ketamine infusion combined with motivational enhancement therapy for alcohol use disorder. (PMID 31786934)
Das RK et al. 2019, Nature Communications — Ketamine reduced harmful drinking by pharmacologically rewriting reward memory. (PMID 31772157)

Last reviewed by Dr. Ben Soffer, DO on June 2, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.